**Acknowledgements**

dendrimers, and an antibiotic that is inside of a polymer nanoparticles capsules, and inorganic nanoparticles with antibiotic molecules attached to the surfaces [61]. In this study, silver nanoparticles coated with a water-soluble polymer called polyvinylpyrrolidone were used to combat nanomaterial-resistant organisms [61]. This experiment proved that nanomaterial combinations are able to perform like an antibiotic and to be toxic to *Pseudomonas aeruginosa* bacteria which was resistant to multiple drugs [61]. The results of this study are in line with the previous reports on the silver-based polymers used as antimicrobial biomaterials for

Nanomaterials have been considered as a defense against multiple drug resistance because of their antimicrobial activity [59, 61, 62, 67]. Antibacterial activities of nanoparticles depend on two fundamental elements, physicochemical properties of nanoparticles and type of target bacteria. Regardless of the fact that there is a correlation in a couple of aspects of the antibacterial activity of nanoparticles, singular investigations are challenging to generalize since most of the researchers perform experiments using accessible nanoparticles and bacteria, rather than targeting particular and preferred nanoparticles or bacteria [68]. Nanoparticles which are utilized in lab-scale studies are not well-known and correlating them with physicochemi-

A mix of nanomaterials and molecular antibiotics draws in much consideration recently, since they are effective in killing multi-drug resistant isolates of pathogenic bacterial species and

Nanomaterials play controversial roles in regard to antibiotic resistance; on one hand, as mentioned before, they have been considered as a defense against multiple drug resistance because of their antimicrobial activity, and on the other hand, they can encourage the development of antibiotic resistance in the environment [56, 70]. Overall, more information is needed concerning the mechanisms behind the antimicrobial activity of nanomaterials and their potential for

Antibiotic resistance development among bacteria is a challenging issue that requires improvement of next-generation treatment processes in WWTPs. The emergence of antibiotic resistance between pathogens increases the demand for effective treatment strategies.

• Assessment of the effect of operating conditions (pH, free available chlorine, HRT, SRT, Biomass concentration) and environmental factors (temperature, COD, BOD, water flow

• Determination of dominant mechanisms (mutation, selection, mechanisms of genetic exchange including conjugation, transduction, and transformation) of ARGs development, and

• Future studies should be done on the more extensive spectrum of ARBs and ARGs like

water treatment [65, 66].

86 Antimicrobial Resistance - A Global Threat

cal properties for full-scale production is not reliable.

combating an expansive range of ARB and ARGs [56, 69].

**5. Future developments and perspectives**

Knowledge gaps and future research needs are:

influencing the development of resistance in environmental systems.

on ARB and ARGs development during wastewater treatment,

fluoroquinolone, ertapenem, and levofloxacin resistance.

The authors acknowledge funding support from the Department of Civil and Environmental Engineering, the University of North Carolina at Charlotte.
